Delivering a Quality LIS

1
Delivering a Quality LIS
Stephen Balmer
CPD4IT (Scotland) Meeting
25th November 2008
Wishaw General Hospital
2

• A bit of History

• Middle Ages

• Future Direction

Slide 1 of 232
3
A Bit of History

• Laboratory methodology a generation more
  primitive

• Computing technology a generation more
  primitive

• Hospital Data Flow almost entirely manual

• Laboratory Data Flow mostly manual with some
  locally innovative computing

• Data volume extremely small compared to current
  volume

Slide 2 of 232
4
Slide 3 of 232
5
Slide 4 of 232
6
Slide 5 of 232
7
..as time goes by

• Databases start to emerge generally through
  local skills and resource

• Sample tracking

• Online result availability

• Printed reports

• Stats !!

8
..wouldnt it be good if

• Auto analysers proliferate across Blood
  Sciences

• Laboratory equipment interfacing - manual

• Laboratory equipment interfacing - computer

• Sample management within laboratory

• Laboratory System Model realised

9
(No Transcript)
10
The Big Break

• Formal LIS Implemented

• Full end to end computerisation of sample
  management

• Key analysers interfaced

• Automated, formatted report printing

• Rapid access to useful statistical information

11
Middle Ages

• Introduction of Middleware

• Introduction of electronic reporting

• Introduction of auto analysers to other
  disciplines

• Requirement for formal Statistical Reporting

• Introduction of Electronic Requesting

12
Why did Labs Start Using Middleware - Cost
13
Why did Labs Start Using Middleware

• Improves sample management and analytical
  platform integration

• Improves Efficiency and Productivity

• Automates Manual Processes

• Provides consistent, rule based advised result
  validation

• Reduces the potential for error

• Improves Turnaround Time

• Provides Backup and Resilience to the Laboratory.

14
Middle Ages

• Middleware proliferating across all disciplines

• Mandate of electronic reporting (PMIP)

• Electronic Requesting now panacea in secondary
  care setting

• Electronic Requesting highly desirable within
  primary care setting

• Rapid rise in laboratory automation

15
So where are we?
16
(No Transcript)
17
(No Transcript)
18
Future Direction

• What is the future role of the LIS in
  Laboratory Medicine / Patient Care ?

• Does One System fit all ?

• Is our Laboratory Service in final
  configuration ?

• Do we have the resource to dedicate to
  implementation ?

• Is there anything to move to ?

19
Future Direction

• Biochemistry predominantly automated, little
  technological advance ?

• Haematology predominantly automated, some
  microscopy possibilities ?

• Blood Transfusion significantly automated,
  some stock management advances ?

• Microbiology becoming more automated,
  microscopy advances ?

• Pathology slowly automating, microscopy and
  work distribution possibilities ?

20
Blood Transfusion

• Vein to vein traceability and retrospective
  audit

• Maintenance of enough information to support
  Electronic Issue

• Serological and compatibility testing pretty
  well automated.

21
Microbiology

• Recent introduction and increased use of data
  managers as analysers proliferate

• Greater support for epidemiological information
  and infection control assistance

• Hardware improvement for hot bench working

• Microscopy automation ?

22
Pathology

• Is this actually more aligned with Radiology ?

• Greater support for sample tracking around
  laboratory and between laboratories

• Greater support for artistry !

• Greater support for voice technologies

• Greater support for Reporting Recommendation /
  Mandate

• Microscopy automation ?

23
Microscopy Advances
Some Observations on Slide Density
Characteristics

• 2.5cm x 7.5cm

2.5cm

• 1/3 used for label

• 2.5cm x 5.0cm used for tissue display

7.5cm

• Typical light microscopy is diffraction-limited
  to 0.25 microns

5cm

• Yields an effective required pixel count of
  100K by 200K pixels or a 20K Mpixel Image

• This is the same as saying one would require
  20K images with a 1MPixel camera to obtain a
  dimensioned image of a single slide

• With previous search technology it would take
  119 years to search 10,000 slides !

24
Vector Quantization
25
(No Transcript)
26
Microscopy Automation

• Vector Quantization computerised solution to
  slide reading

• Processing and storage much reduced but still
  massive

• Still requires Skilled intervention

• Performs as a Specialist System

• What is a Specialist ?

Someone who is very confident about the limits
of their own knowledge
- Know what you dont know and know when to
consult

• In proper configuration, vectorizing solutions
  can provide decision support in this manner.

27
The Resource Issue

• Generally, dedicated Laboratory IT expertise
  has diminished

• Does It actually require that much IT expertise
  anyway?

• What IT expertise that exists, usually also has
  a day job !

• Have we got the monetary resource to pursue ?

28
Logistics

• Are our Labs in Final Configuration NO!

• Are the days of locally procured solutions gone
  ?

• How long to procure / buy / implement 3 / 4
  years ?

• As system interdependencies grow, is this a
  bonus or a problem ?

• Would it ever get finished in todays project
  hungry environment ?

29
Is there anything to buy

• We all generally like our current LIS

• There is at least 25 years of functionality
  development in our current systems

• The purpose must be to improve not just change

• The National strategy might dictate anyway

30
Epidemiological Reporting
Infection Control
Result Publication Support
Hospital System
Image capture retrieval
Primary Care System
E-mail capability
Voice Technology
SMS capability
Microscopy Expert System
Statistical Reporting
Blood Tracking
Electronic Requesting Support
Electronic Requesting Support
Lab to Lab communication